The uninsured in U.S. raise Ebola risk
Want to stop Ebola in the U.S.? Make sure everyone gets fast care even if they don't have insurance.
By Laurie Garrett
The Chicago Tribune, Oct. 2, 2014
Fear of Ebola has been climbing steadily in the United States since Tuesday's announcement that a Liberian traveler in Dallas, Thomas Eric Duncan, was diagnosed with the disease after having been in Texas for eight days.
A month ago, a Harvard School of Public Health poll found that 39 percent of Americans thought an Ebola outbreak would come to the United States, and 26 percent felt concerned that they or a member of their family would get the disease. ...
[The case] has drawn our attention to America's unique vulnerability to contagious diseases: our health system. ...
America's special risk, not shared by our Canadian neighbors or European friends, is the 13.8 percent of Americans — about 43.3 million individuals — who still lack health insurance, and millions more whose policies entail copayments that are exorbitant for working people. These are the Americans who routinely tough out the flu, fever, aches and pains because seeking medical care is prohibitively expensive. If they become sick enough to feel desperate, the uninsured and underinsured of America go to public hospital emergency rooms for care, where waiting times in often-crowded settings can stretch on for hours. This reality is compounded by a weakened public health infrastructure: 52 health agencies, including 48 states, three territories and Washington, D.C., have reported budget cuts since 2008. ...
America's special vulnerability to Ebola is its limitations on access to health care. In times of contagion, societal risk rises with every uninsured or underinsured individual who struggles to work or goes to school with a fever and avoids bankrupting visits to health providers. ...
Laurie Garrett is senior fellow for global health at the Council on Foreign Relations and a Pulitzer Prize-winning science writer.
By Laurie Garrett
The Chicago Tribune, Oct. 2, 2014
The Chicago Tribune, Oct. 2, 2014
Fear of Ebola has been climbing steadily in the United States since Tuesday's announcement that a Liberian traveler in Dallas, Thomas Eric Duncan, was diagnosed with the disease after having been in Texas for eight days.
A month ago, a Harvard School of Public Health poll found that 39 percent of Americans thought an Ebola outbreak would come to the United States, and 26 percent felt concerned that they or a member of their family would get the disease. ...
[The case] has drawn our attention to America's unique vulnerability to contagious diseases: our health system. ...
America's special risk, not shared by our Canadian neighbors or European friends, is the 13.8 percent of Americans — about 43.3 million individuals — who still lack health insurance, and millions more whose policies entail copayments that are exorbitant for working people. These are the Americans who routinely tough out the flu, fever, aches and pains because seeking medical care is prohibitively expensive. If they become sick enough to feel desperate, the uninsured and underinsured of America go to public hospital emergency rooms for care, where waiting times in often-crowded settings can stretch on for hours. This reality is compounded by a weakened public health infrastructure: 52 health agencies, including 48 states, three territories and Washington, D.C., have reported budget cuts since 2008. ...
America's special vulnerability to Ebola is its limitations on access to health care. In times of contagion, societal risk rises with every uninsured or underinsured individual who struggles to work or goes to school with a fever and avoids bankrupting visits to health providers. ...
Laurie Garrett is senior fellow for global health at the Council on Foreign Relations and a Pulitzer Prize-winning science writer.
Health Care Marketplaces Expand, but Answers for Shoppers Remain Scarce
Last week, the Department of Health and Human Services announced that the number of insurers participating in state marketplaces was on the rise. But it didn’t say whether that improved competition was taking place everywhere, or just in the urban markets that already had a lot of insurance carriers.
The week before, it announced that 7.3 million Americans were currently enrolled in marketplace plans created by the Affordable Care Act. But it didn’t share a breakdown by health plan, state, age or income.
These recent data releases from the department paint an upbeat picture of the act’s progress so far. But the lack of detail makes it difficult to know whether its programs are working well for all the groups they were designed to serve. This is not to say that the department is hiding anything; in both cases, the department simply doesn’t have many of those details — a disquieting thought less than two months before open enrollment begins for 2015.
Care at the End of Life
Americans are justifiably worried about obtaining the best possible care — and the care they really want — as they or family members near the end of life. All too often, the care is shoddy or contrary to a patient’s wishes.
Consider what happened when a middle-aged daughter in New York City sought care for her ailing father, only to be frustrated at every turn by rules and institutions that operated at cross-purposes and failed to focus on the needs of the patient. Her ordeal was described by Nina Bernstein in The Times last week.
The woman’s father was bounced back and forth among hospitals, nursing homes and home care agencies that often latched on to the patient when it was in their economic interest to do so but shunted him aside when the profit margins shrank. In the end, he was unable to get home hospice care, as he and his daughter had wanted.
The father was eligible for both Medicare, the federal insurance program for the elderly and disabled, and Medicaid, the state-federal insurance program for the poor, but he confronted a big problem. Once Medicare started paying for his home care, bureaucratic barriers made it virtually impossible to have Medicaid continue to pay for aides to perform personal care, such as feeding, bathing and changing clothes. Future patients may fare better. In June 2013, New York State clarified that personal care services can continue while a patient with a life expectancy of six months or less receives hospice services.
Two issues raised by this case seem particularly troubling. Virtually every institution took actions that served its own needs, not the patient’s. And there was no coordination between Medicare and Medicaid.
Patients may soon get help. The state says it will appoint ombudsmen to protect patients’ interests in seeking community or home care, at no cost to enrollees.
Beware of Shifting Options Within Medicare Plans
For millions of older Americans, it is time to sift through the mind-boggling array of Medicare plans.
There is an average of 29 drug plans to digest, and about 18 options for Medicare Advantage, the plans delivered through private insurers. Then there are the 10 supplemental plans that cover what traditional Medicare does not.
The choices can be paralyzing for anyone, and they can be even more challenging as you age. The Medicare open enrollment season, which runs from Oct. 15 through Dec. 7, gives individuals a chance to rethink it all and reassess whether their plan still fits their needs.
While no broad-based changes are expected, there could be meaningful shifts within individual plans. Maybe your Part D prescription plan will no longer pay for one of your drugs, or you started a new one. Perhaps your Medicare Advantage plan dropped your favorite doctor (or worse, a cancer treatment center) from network.
“People treat this as a momentous decision but they get scared of it, and the thing that worries me is that they don’t make the changes that they should,” said Joe Baker, president of the Medicare Rights Center in New York. “Don’t stay in a plan because you’re overwhelmed with the choices.”
Antibiotics in Livestock: F.D.A. Finds Use Is Rising
The amount of antibiotics sold for use in livestock rose substantially in recent years, according to the Food and Drug Administration, a pattern that experts said was troubling given the efforts to battle antibiotic resistance in humans.
In an annual report posted online on Thursday, the agency said the amount of medically important antibiotics sold to farmers and ranchers for use in animals raised for meat grew by 16 percent from 2009 to 2012.
Most troubling, health advocates say, was a rise in the sale of cephalosporins, a class of drug that is important in human health, despite new restrictions the F.D.A. put into place in early 2012. The report showed an 8 percent increase in the sale of those drugs in 2012, confirming advocates’ fears that the agency’s efforts may not be having the desired effect. Sales of those drugs rose by 37 percent from 2009 to 2012.
“We’re concerned that antibiotic sales for food animal production keep increasing,” said Laura Rogers, director of the Campaign on Human Health and Industrial Farming at the Pew Charitable Trusts, a research and advocacy group.
The National Chicken Council, an industry group, said in a statement that the sale of antibiotics did not necessarily correlate with antibiotic resistance trends. It said that most antibiotics used in chicken production were not used in human medicine.
The report did not differentiate by species; it included all animals raised for meat.
Antibiotics were the wonder drugs of the 20th century, and their initial use in humans and animals was indiscriminate, experts say. Farmers learned that antibiotics helped animals grow rapidly, and they began to add the drugs to feed and water, with no prescriptions or sign of sickness in the animals. But it is now known that broad use leads to antibiotic resistance, which means that critical antibiotics are no longer as effective in treating infections in people.
Judge refuses to be pushed around by Partners
Someone who stands up to Partners HealthCare rather than kneels before it?
That’s unusual in Boston. But Superior Court Judge Janet L. Sanders so far has refused to let the powerful network of Harvard-affiliated hospitals and doctors push her around.
Sanders is reviewing what was supposed to be a routine settlement of an antitrust case. But at a recent hearing, she postponed any further action until Nov. 10. Saying she needs more time to weigh the consequences, she expressed serious concerns about the impact of the settlement on the state’s overall health care system and the ultimate cost to consumers.
“This is the wrong venue for that,” Bruce D. Sokler, one of Partners’ lawyers, told the judge. “Your job is not to fix the health care policy system in Massachusetts.”
To his suggestion that she is overstepping her bounds, Sanders replied, “I don’t think that market impact can be ignored.”
Partners is used to getting what it wants — when it wants it. That’s been the pattern since its creation 20 years ago. But now, it’s confronted by a judge who is questioning whether what Partners wants is good for Massachusetts, and she doesn’t want to rush her decision. That’s admirable.
Sanders has the pedigree to challenge the establishment. She is the daughter of a famed Texas judge, Harold Barefoot Sanders, who oversaw the desegregation of Dallas public schools and helped President Johnson push the Voting Rights Act of 1965 through Congress. According to a New York Times obituary, Sanders’ father “walked among the legends who once bestrode Texas politics.”
Why I Hope to Die at 75
An argument that society and families—and you—will be better off if nature takes its course swiftly and promptly
Ezekiel J. Emanuel
Seventy-five.
That’s how long I want to live: 75 years.
This preference drives my daughters crazy. It drives my brothers crazy. My loving friends think I am crazy. They think that I can’t mean what I say; that I haven’t thought clearly about this, because there is so much in the world to see and do. To convince me of my errors, they enumerate the myriad people I know who are over 75 and doing quite well. They are certain that as I get closer to 75, I will push the desired age back to 80, then 85, maybe even 90.
I am sure of my position. Doubtless, death is a loss. It deprives us of experiences and milestones, of time spent with our spouse and children. In short, it deprives us of all the things we value.
But here is a simple truth that many of us seem to resist: living too long is also a loss. It renders many of us, if not disabled, then faltering and declining, a state that may not be worse than death but is nonetheless deprived. It robs us of our creativity and ability to contribute to work, society, the world. It transforms how people experience us, relate to us, and, most important, remember us. We are no longer remembered as vibrant and engaged but as feeble, ineffectual, even pathetic.
By the time I reach 75, I will have lived a complete life. I will have loved and been loved. My children will be grown and in the midst of their own rich lives. I will have seen my grandchildren born and beginning their lives. I will have pursued my life’s projects and made whatever contributions, important or not, I am going to make. And hopefully, I will not have too many mental and physical limitations. Dying at 75 will not be a tragedy. Indeed, I plan to have my memorial service before I die. And I don’t want any crying or wailing, but a warm gathering filled with fun reminiscences, stories of my awkwardness, and celebrations of a good life. After I die, my survivors can have their own memorial service if they want—that is not my business.
Let me be clear about my wish. I’m neither asking for more time than is likely nor foreshortening my life. Today I am, as far as my physician and I know, very healthy, with no chronic illness. I just climbed Kilimanjaro with two of my nephews. So I am not talking about bargaining with God to live to 75 because I have a terminal illness. Nor am I talking about waking up one morning 18 years from now and ending my life through euthanasia or suicide. Since the 1990s, I have actively opposed legalizing euthanasia and physician-assisted suicide. People who want to die in one of these ways tend to suffer not from unremitting pain but from depression, hopelessness, and fear of losing their dignity and control. The people they leave behind inevitably feel they have somehow failed. The answer to these symptoms is not ending a life but getting help. I have long argued that we should focus on giving all terminally ill people a good, compassionate death—not euthanasia or assisted suicide for a tiny minority.
No health care after 75? Time to reconsider
By Jeff Jacoby
| GLOBE COLUMNIST OCTOBER 06, 2014
The elderly are such a pain, aren’t they? Dr. Ezekiel Emanuel thinks so. Half of those older than 80 have “functional limitations,” the prominent health policy analyst and key Obamacare architect writes in the October issue of The Atlantic. One in three Americans 85 and up has Alzheimer’s. Old people are more likely to be disabled, or at least “faltering and declining.” They lose their creative mojo. They don’t “contribute to work, society, the world.” Instead of being regarded as “vibrant and engaged,” they grow “feeble, ineffectual, even pathetic.”
Especially disagreeable are old parents, who can be so irritating: “They set expectations, render judgments, impose their opinions, interfere, and are generally a looming presence for even adult children,” Emanuel complains. By living too long, parents blow their chance to impart “the right memories” to their kids. Nothing could be worse, he insists, than being remembered not as we were in our prime, but as old and decrepit — “stooped and sluggish, forgetful and repetitive, constantly asking, ‘What did she say?’” To leave behind memories of our frailty “is the ultimate tragedy.”
And that, declares Emanuel, is “Why I Hope to Die at 75.”
In his 5,000-word essay, Emanuel — who heads the Department of Medical Ethics and Health Policy at the University of Pennsylvania and has an appointment at the National Institutes of Health — announces that once he reaches 75, he will decline nearly all medical treatment. No more flu shots, no colonoscopies or other screenings, no pacemakers or surgery. “If I develop cancer, I will refuse treatment,” he writes. He won’t even take antibiotics to cure pneumonia or an infection, preferring instead to be carried off by the “quick and relatively painless” death untreated infection usually leads to.
Or so he says.
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